Leticia Márquez-Magaña

Factors influencing time to diagnosis after abnormal mammography in diverse women.

BACKGROUND Abnormal mammograms are common, and the risk of false positives is high. We surveyed women in order to understand the factors influencing the efficiency of the evaluation of an abnormal mammogram. METHODS Women aged 40-80 years, identified from lists with Breast Imaging Reporting and Data System (BIRADS) classifications of 0, 3, 4, or 5, were surveyed. Telephone surveys asked about the process of evaluation, and medical records were reviewed for tests and timing of evaluation. RESULTS In this study, 970 women were surveyed, and 951 had chart reviews. Overall, 36% were college graduates, 68% were members of a group model health plan, 18% were Latinas, 25% were African Americans, 15% were Asian, and 43% were white. Of the 352 women who underwent biopsies, 151 were diagnosed with cancer (93 invasive). Median time to diagnosis was 183 days for BIRADS 3 compared to 29 days for BIRADS 4/5 and 27 days for BIRADS 0. At 60 days, 84% of BIRADS 4/5 women had a diagnosis. Being African American (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.49-0.97, p=0.03), income < 

Investigative Cases and Student Outcomes in an Upper-Division Cell and Molecular Biology Laboratory Course at a Minority-serving Institution

10,000 (HR 0.55, 95% CI 0.31-0.98, p<0.04), perceived discrimination (HR 0.22, 95% CI 0.09-0.52, p<0.001), not fully understanding the results of the index mammogram (HR 0.49, 95% CI 0.32-0.75, p=0.001), and being notified by letter (HR 0.66, 95% CI 0.48-0.90, p=0.01) or telephone (HR 0.62, 95% CI 0.42-0.92, p=0.02) rather than in person were all associated with significant delays in diagnosis. CONCLUSIONS Evaluation of BIRADS 0, 4, or 5 abnormal mammograms was completed in most women within the recommended 60 days. Even within effective systems, correctible communication factors may adversely affect time to diagnosis.

Classroom sound can be used to classify teaching practices in college science courses

Active-learning strategies are increasingly being integrated into college-level science courses to make material more accessible to all students and to improve learning outcomes. One active-learning pedagogy, case-based learning (CBL), was developed as a way to both enhance engagement in the material and to accommodate diverse learning styles. Yet, adoption of CBL approaches in undergraduate biology courses has been piecemeal, in part because of the perceived investment of time required. Furthermore, few CBL lesson plans have been developed specifically for upper-division laboratory courses. Here, we describe four cases that we developed and implemented for a senior cell and molecular biology laboratory course at San Francisco State University, a minority-serving institution. To evaluate the effectiveness of these modules, we used both written and verbal assessments to gauge learning outcomes and attitudinal responses of students over two semesters. Students responded positively to the new approach and seemed to meet the learning goals for the course. Most said they would take a course using CBL again. These case modules are readily adaptable to a variety of classroom settings.

Debunking ‘Race’ and Asserting Social Determinants as Primary Causes of Cancer Health Disparities: Outcomes of a Science Education Activity for Teens

Significance Although the United States needs to expand its STEM (science, technology, engineering, mathematics) workforce, United States postsecondary institutions struggle to retain and effectively teach students in STEM disciplines. Using teaching techniques beyond lecture, such as pair discussions and reflective writing, has been shown to boost student learning, but it is unknown what proportion of STEM faculty use these active-learning pedagogies. Here we describe DART: Decibel Analysis for Research in Teaching, a machine-learning–derived algorithm that analyzes classroom sound to predict with high accuracy the learning activities used in classrooms, and its application to thousands of class session recordings. DART can be used for large-scale examinations of STEM teaching practices, evaluating the extent to which educators maximize opportunities for effective STEM learning. Active-learning pedagogies have been repeatedly demonstrated to produce superior learning gains with large effect sizes compared with lecture-based pedagogies. Shifting large numbers of college science, technology, engineering, and mathematics (STEM) faculty to include any active learning in their teaching may retain and more effectively educate far more students than having a few faculty completely transform their teaching, but the extent to which STEM faculty are changing their teaching methods is unclear. Here, we describe the development and application of the machine-learning–derived algorithm Decibel Analysis for Research in Teaching (DART), which can analyze thousands of hours of STEM course audio recordings quickly, with minimal costs, and without need for human observers. DART analyzes the volume and variance of classroom recordings to predict the quantity of time spent on single voice (e.g., lecture), multiple voice (e.g., pair discussion), and no voice (e.g., clicker question thinking) activities. Applying DART to 1,486 recordings of class sessions from 67 courses, a total of 1,720 h of audio, revealed varied patterns of lecture (single voice) and nonlecture activity (multiple and no voice) use. We also found that there was significantly more use of multiple and no voice strategies in courses for STEM majors compared with courses for non-STEM majors, indicating that DART can be used to compare teaching strategies in different types of courses. Therefore, DART has the potential to systematically inventory the presence of active learning with ∼90% accuracy across thousands of courses in diverse settings with minimal effort.

Collectively Improving Our Teaching: Attempting Biology Department–wide Professional Development in Scientific Teaching

Cancer health disparities are often described as the unequal burden of cancer deaths in one racial/ethnic group compared to another. For example, national cancer statistics in the USA shows that Blacks die the most for 9 of the top 10 cancers in men and women. When asked about the underlying causes for this disparity, teen participants speculated that it is primarily due to genetics or biology. This speculation appears to be based on a false concept of ‘race.’ A science activity was created to counter the false concept that genetics/biology underlie the categorization of humans into different ‘races.’ This activity provided teen participants with first-hand evidence of how they are all related at one genetic locus, and how they are more genetically related across racial/ethnic groups than within them. Results of surveys given before and after the activity show that they change their perceptions of ‘race.’ Before the activity, they view themselves as most related at the genetic level to 1–2 well-known individuals (i.e., celebrities) who they perceive as members of their own ‘race’ mainly because of similar appearance. After the activity, they view themselves as related to more/all the celebrities or they state that they do not know to whom they are most related. This increased awareness of the uncertainty between the apparent ‘race’ of an individual and their genetics drives teens to dismiss genetics or biology as the primary cause of racial/ethnic disparities in cancer outcomes. Instead, they consider the unequal distribution of the social determinants of health as the primary cause of cancer disparities.

Enhancing Biospecimen Knowledge Among Health Care Providers and Representatives From Community Organizations

A collaborative professional development program that engaged nearly 90% of faculty in a biology department in more than 40 hours of training on scientific teaching was instituted. Participating instructors integrated active learning in their courses, as shown through a variety of methods, and reported positive effects on teaching and departmental community.

‘Speaking Truth’ Protects Underrepresented Minorities’ Intellectual Performance and Safety in STEM

In a personalized medicine environment, it is necessary to have access to a range of biospecimens to establish optimal plans for disease diagnosis and treatment for individual patients. Cancer research is especially dependent on biospecimens for determining ideal personalized treatment for patients. Unfortunately, the vast majority of biospecimens are collected from non-Hispanic White individuals; thus, minority representation is lacking. This has negative implications for comprehensive cancer treatment. The Geographic Management of Cancer Health Disparities Program (GMaP) Region 6 implemented a series of biospecimen education seminars adapted from the Biospecimen and Biobanking module of an existing Cancer Education and Training Program. Regional GMaP partners participated in a train-the-trainer webinar to familiarize themselves with the training materials. Participants trained by the trainers completed pre- and posttests to document changes in awareness, knowledge, and intention. Nine biospecimen education seminars were offered in 2013; 255 health care professionals and representatives from community organizations attended. Participants demonstrated a significant increase in knowledge, intention to donate samples, and intention to talk to patients about biospecimen sample donation. Representatives from community organizations had more improvement on knowledge scores than health care providers. Participation in a well-designed biospecimen education program may ameliorate some of the distrust of biomedical research experienced by racial/ethnic minorities and, in turn, increase needed minority representation in biospecimen collection.

Gut Microbiota Composition is Related to Cardiorespiratory Fitness in Healthy Young Adults

We offer and test a brief psychosocial intervention, Speaking Truth to EmPower (STEP), designed to protect underrepresented minorities’ (URMs) intellectual performance and safety in science, technology, engineering, and math (STEM). STEP takes a ‘knowledge as power’ approach by: (a) providing a tutorial on stereotype threat (i.e., a social contextual phenomenon, implicated in underperformance and early exit) and (b) encouraging URMs to use lived experiences for generating be-prepared coping strategies. Participants were 670 STEM undergraduates [URMs (Black/African American and Latina/o) and non-URMs (White/European American and Asian/Asian American)]. STEP protected URMs’ abstract reasoning and class grades (adjusted for grade point average [GPA]) as well as decreased URMs’ worries about confirming ethnic/racial stereotypes. STEP’s two-pronged approach—explicating the effects of structural ‘isms’ while harnessing URMs’ existing assets—shows promise in increasing diversification and equity in STEM.

Enabling full representation in science: the San Francisco BUILD project’s agents of change affirm science skills, belonging and community

Bacteria residing in the human gastrointestinal tract has a symbiotic relationship with its host. Animal models have demonstrated a relationship between exercise and gut microbiota composition. This was the first study to explore the relationship between cardiorespiratory fitness (maximal oxygen consumption, VO2max) and relative gut microbiota composition (Firmicutes to Bacteroidetes ratio [F/B]) in healthy young adults in a free-living environment. Twenty males and 17 females (25.7 ± 2.2 years), who did not take antibiotics in the last 6 months, volunteered for this study. VO2max was measured using a symptom-limited graded treadmill test. Relative microbiota composition was determined by analyzing DNA extracted from stool samples using a quantitative polymerase chain reaction that specifically measured the quantity of a target gene (16S rRNA) found in Firmicutes and Bacteroidetes. Relationships between F/B and potentially related dietary, anthropometric, and fitness variables were assessed using correlation analyses with an appropriate Bonferroni adjustment (p < .004). The average F/B ratio in all participants was 0.94 ± 0.03. The F/B ratio was significantly correlated to VO2max (r = .48, p < .003), but no other fitness, nutritional intake, or anthropometric variables (p > .004). VO2max explained ∼22% of the variance of an individuals relative gut bacteria as determined by the F/B ratio. These data support animal findings, demonstrating a relationship between relative human gut microbiota composition and cardiorespiratory fitness in healthy young adults. Gastrointestinal bacteria is integral in regulating a myriad of physiological processes, and greater insight regarding ramifications of exercise and nutrition on gut microbial composition may help guide therapies to promote human health.

Evaluation of cortisol and telomere length measurements in ethnically diverse women with breast cancer using culturally sensitive methods

BackgroundThe underrepresentation of minority students in the sciences constrains innovation and productivity in the U.S. The SF BUILD project mission is to remove barriers to diversity by taking a “fix the institution” approach rather than a “fix the student” one. SF BUILD is transforming education, research, training, and mentoring at San Francisco State University, a premiere public university that primarily serves undergraduates and ethnic minority students. It boasts a large number of faculty members from underrepresented groups (URGs), including many of the project leaders. These leaders collaborate with faculty at the University of California San Francisco (UCSF), a world-class medical research institution, to implement SF BUILD.Key highlightsTogether, the campus partners are committed to creating intellectually safe and affirming environments grounded in the Signaling Affirmation for Equity (SAFE) model, which is based on robust psychosocial evidence on stereotype threat and its consequences. The SAFE model dictates a multilevel approach to increasing intent to pursue a biomedical career, persistence in STEM fields, and productivity (e.g. publications, presentations, and grants) by implementing transformative activities at the institutional, faculty, and student levels. These activities (1) increase knowledge of the stereotype threat phenomenon; (2) affirm communal and altruistic goals of students and faculty to “give back” to their communities in classrooms and research activities; and (3) establish communities of students, faculty and administrators as “agents of change.” Agents of change are persons committed to establishing and maintaining SAFE environments. In this way, SF BUILD advances the national capacity to address biomedical questions relevant to communities of color by enabling full representation in science.ImplicationsThis chapter describes the theoretical and historical context that drive the activities, research and evaluation of the SF BUILD project, and highlights attributes that other institutions can use for institutional change. While this paper is grounded in psychosocial theory, it also provides practical solutions for broadening participation.